Emergency Severity Index (ESI) Handbook - 5th Edition

Overview

• Developed by Emergency Nurses Association (ENA).
• Standardized tool for triaging patients in Emergency Departments (EDs).
• ESI categorizes patients into five levels based on urgency:
  • Level 1: Most urgent, requires immediate lifesaving intervention.
  • Level 5: Least urgent, requires minimal resources.
• Originally developed in 1998, refined over the years.

Importance of ESI

• Addresses emergency department crowding by prioritizing care.
• Standardizes triage processes across EDs for consistency and safety.
• Supported by ACEP and ENA for scientific validation and extensive use.

ESI Algorithm

Decision Points

1. Decision Point A: Unstable and requires immediate lifesaving intervention?

   • Criteria for Level 1 include: ineffective airway clearance, severe respiratory distress, anaphylaxis, etc.

2. Decision Point B: High-Risk Situation?

   • Assesses potential deterioration; ESI Level 2 for patients with high-risk situations or severe pain/distress.
   • Includes considerations for mental status and physiological distress.

3. Decision Point C: Resource Needs?

   • Determines the expected resources needed for care beyond lifesaving interventions.
   • Guides levels 3, 4, and 5 based on the number of resource types needed.

4. Decision Point D: High-Risk Vital Signs?

   • Identifies patients appearing stable but have abnormal vital signs indicating potential instability.

Vital Signs Assessment

• Critical for determining patient acuity, especially in levels 3, 2, and 1.
• Specific thresholds for adults and pediatric patients.

Special Considerations

• Bias and stigma can lead to inaccurate triage; importance of objective assessment.
• ESI is used as a guide, not for ongoing patient monitoring post-triage.
• Pediatric and geriatric patient considerations require additional attention due to differing physiological responses.

Benefits of ESI

• Rapid identification and prioritization of urgent cases.
• Improved communication among ED staff regarding patient acuity.
• Supports research and benchmarking in emergency care.

Implementation and Training

• Requires experienced triage nurses or those who have completed comprehensive triage education.
• Not a replacement for complete triage educational programs.

Conclusion

• ESI is a crucial tool in emergency department triage for efficient and effective patient care.
• Ongoing education and evaluation are necessary to maintain accuracy and effectiveness in patient sorting.